Tools such as the Psoriasis Area and Severity Index (PASI) may be used to express disease severity, based on severity of lesions and extent of skin involvement. Methotrexate is useful for extensive chronic plaque psoriasis in patients who are inadequately controlled by topical therapy alone, or where there is concomitant psoriatic arthropathy. Objective assessment of the body surface area (BSA) involvement, disease location, thickness and symptoms, presence or absence of psoriatic arthritis, and any associated comorbidities. Chronic plaque psoriasis usually presents as red, scaly patches of skin with very well defined edges. How does having psoriasis affect the patient’s daily life, at home, work or school?. Determining how the patient perceives their disability as this will often dictate the need and type of treatment. Draft 20 March 2014. Erythrodermic psoriasis denotes the involvement of the entire skin surface which, although rare, is significant because it can be life threatening with a risk of sepsis and thermoregulatory disruption.
Treatment is based on surface areas of involvement, body site(s) affected, the presence or absence of arthritis, and the thickness of the plaques and scale. Chronic stationary psoriasis (psoriasis vulgaris): Most common type of psoriasis; involves the scalp, extensor surfaces, genitals, umbilicus, and lumbosacral and retroauricular regions. Plaque psoriasis: Most commonly affects the extensor surfaces of the knees, elbows, scalp, and trunk. Scalp psoriasis: Affects approximately 50 of patients. Psoriasis is a common; typically chronic papulosquamous skin disease that may be associated with a seronegative spondyloarthropathy. Psoriasis may begin at any age however generally there are two peaks of onset, the first at 20-30 years and the second at 50-60 years. Plaque-type psoriasis, or psoriasis vulgaris, is the most common form, occurring in about 80 of all psoriasis patients. Psoriasis is a common chronic skin disorder typically characterized by erythematous papules and plaques with a silver scale, although other presentations occur. Patients with more than 5 to 10 percent body surface area affected are generally candidates for phototherapy or systemic therapy, since application of topical agents to a large area is not usually practical or acceptable for most patients.
Plaque psoriasis can appear on any skin surface, although the knees, elbows, scalp, trunk and nails are the most common locations. Feldman et al (2002) reported on a multi-center study of the excimer laser involving 124 patients with stable mild-to-moderate plaque-type psoriasis; In 38.6 of patients, less than 10 of body surface area (BSA) was affected. Joint involvement was reported in 28.8 of patients. Hypertension and diabetes were present in 20.3 and 11.1 of patients, respectively. The most frequent manifestation of psoriasis in all these studies is chronic plaque-type psoriasis,9,10 as in our study. 4 The course of the disease is unpredictable, with patients generally having multiple remissions and relapses that require repeated and prolonged courses of therapy throughout life. Furthermore, the approximately 50 reduction in the PASI score observed in the acitretin plus placebo group is in agreement with a previous study by Olsen et al,10 who observed a similar improvement in erythema, scaling, and induration after 20 weeks of acitretin therapy.
Psoriasis: Practice Essentials, Background, Pathophysiology
Psoriasis is a chronic inflammatory skin disorder that is characterized by thickened, scaly plaques, and is estimated to affect 1 3 of the Caucasian population. However, the lesions may be widespread and cover up to 90 of the BSA. 0.1, for the treatment of stable plaque psoriasis of up to 20 BSA involvement. It is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy. The mean BMD decreased over time for the entire set of patients tested in the trials, with some having decreases close to 30. Highest incidence was noted in the age group of 20-39 years and the mean age of onset in males and females was comparable. Chronic plaque type psoriasis was the most common (90) clinical phenotype.